Placenta Praevia at Usmanu Danfodiyo University Teaching Hospital; Sokoto: a 5-year review

Background : Placenta praevia is one of the most acute life-threatening obstetric emergencies. Its prompt management has been advocated to prevent associated morbidity and mortality. This study determines the incidence; risk factors; presentation; and maternal/fetal morbidity and mortality associated with placenta praevia in Usmanu Danfodiyo University Teaching Hospital; Sokoto. Materials and Methods : In this retrospective study; case notes of patients' that had placenta praevia from January 1; 2003 to December 31; 2007 were retrieved. Relevant data were extracted and analyzed using the Epi-info Version 3.5.1 statistical package. Results : The incidence of placenta praevia was 0.84. Grand multiparous women (50.0) were more affected than multiparous women (42.7). Majority (46.9) presented with vaginal bleeding after 28 weeks of gestation. The Major type of placenta paevia (77.1) occurred more than the Minor variety (22.9). The most common risk factor was previous abortion (18.75) while anemia (7.3) was the most common complication. Most (83.3) were delivered by Caesarean section. There was one (1.0) maternal mortality and 12 (12.5) perinatal deaths. Conclusions : Placenta praevia has a low incidence in the study population; is mainly of the Major type with identifiable risk factors and occur mainly in the 21-30 years age group and multiparous women. The major modes of presentations are vaginal bleeding and threatened abortion. Though maternal mortality is low perinatal mortality is high

Placenta Praevia at Usmanu Danfodiyo University Teaching Hospital; Sokoto: A 5-Year Review

Background : Placenta praevia is one of the most acute life-threatening obstetric emergencies. Its prompt management has been advocated to prevent associated morbidity and mortality. This study determines the incidence; risk factors; presentation; and maternal/fetal morbidity and mortality associated with placenta praevia in Usmanu Danfodiyo University Teaching Hospital; Sokoto. Materials and Methods : In this retrospective study; case notes of patients' that had placenta praevia from January 1; 2003 to December 31; 2007 were retrieved. Relevant data were extracted and analyzed using the Epi-info Version 3.5.1 statistical package. Results : The incidence of placenta praevia was 0.84. Grand multiparous women (50.0) were more affected than multiparous women (42.7). Majority (46.9) presented with vaginal bleeding after 28 weeks of gestation. The Major type of placenta paevia (77.1) occurred more than the Minor variety (22.9). The most common risk factor was previous abortion (18.75) while anemia (7.3while anemia (7.3) was the most common complication.) were delivered by Caesarean section. There was one (1.0) maternal mortality and 12 (12.5) perinatal deaths. Conclusions : Placenta praevia has a low incidence in the study population; is mainly of the Major type with identifiable risk factors and occur mainly in the 21-30 years age group and multiparous women. The major modes of presentations are vaginal bleeding and threatened abortion. Though maternal mortality is low perinatal mortality is high

Risk Factors for Placenta Praevia in Jos; North Central Nigeria

Background: Placenta praevia; a major cause of obstetric haemorrhage; is potentially lifethreatening to the mother and frequently results in high perinatal morbidity and mortality. Several epidemiological and clinical studies report disparate data on the risk factors associated with this condition. Although several studies on risk factors for placenta praevia have been published; data obtained from the sub-Saharan Africa remains scanty. Our objective is to describe the spectrum of risk factors for placenta praevia in Jos; North Central Nigeria. Methods: This was a retrospective cohort study of 96 women delivered form January; 1999 to December; 2002 at Jos University Teaching Hospital; Jos; Nigeria. Data on total number of deliveries; maternal age; parity; and past obstetrics history and abortion were carefully extracted from medical records and analyzed using the Epi Info 3.4.1 (CDC; Atlanta; Georgia). Results: The prevalence of placenta praevia was 0.89. Previous uterine evacuation was documented in 35.4of cases; while previous caesarean section scar occurred in 5.2of cases. About half (44.8) of the cases had no known risk factor. Conclusion: Uterine scaring following abortion management is an important risk factor for placenta praevia. However; majority of patients with placenta praevia in this work have no identifiable risk factor

Placenta Praevia at the University of Port Harcourt Teaching Hospital: a Five Year Retrospective Study

Placenta praevia is a major cause of obstetric haemorrhage commonly encountered in clinical practice in our environment. It is a life threatening condition both to the mother and her baby.To report the incidence of placenta praevia and describe its clinical presentation; associated risk factors and maternal and perinatal outcomes over a five year period at the University of Port Harcourt Teaching Hospital; Port Harcourt. A cross-sectional study design was employed in the review of hospital records of all women who had placenta praevia and had labour/delivery services at the University of Port Harcourt Teaching Hospital between January 2002 and December 2006. Simple frequencies; cross tabulations and summary statistics were computed and analysed using SPSS version 11 soft ware. Chi-square test of significance was used to compare proportions at P-value- 0.05.One hundred and forty cases of placenta praevia were observed over five years; giving a yearly rate of 28 cases; and an incidence rate of 1.0out of 13;870. One hundred and eighteen women (93.6) had vaginal bleeding out of which 96 (76.1) were painless vaginal bleeding. The mean time from onset of vaginal bleeding to presentation in hospital was 10.98(+ 13.08) hours. The commonly identified known risk factors were induced abortion (50) and previous caesarean section (25). The average time of hospitalization was 13.83 (+ 9.76) days. One hundred and fourteen cases (90.5) had diagnosis confirmed by ultrasound scan while twelve cases (9.5) had Examination Under Anaesthesia (EUA). The mean gestational age at delivery was 37.1 weeks. Caesarean delivery was performed for 101 (80) cases; while 25 (20) had vaginal delivery. There was one maternal death. Thirty two (25.3) babies had birth asphyxia. The perinatal mortality rate was 61.5/1;000 total births. Placenta praevia is still an important obstetric problem in our environment. Despite the fact that most of our women present late; the availability of blood transfusion services; adequate manpower; ultrasound scan and neonatal intensive care facilities have contributed immensely to improve maternal and fetal outcome of this condition in our centre

Risk factors for Placenta Praevia Presenting with severe Vaginal Bleeding in Mulago Hospital; Kampala; Uganda

Objective: To determine the risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital; Kampala; Uganda. Design: A case control study. Set- ting: Mulago hospital labour suite Participants: Between 15th November 2001 and 30th November 2002 we identified and recruited thirty six parturients with placenta previa who developed severe bleeding and 180 women with normal delivery. The risk factors were studied. Variables of interest: Socio demographic characteristics; social and family history; gynaecological operations; blood transfusion; medical conditions; past and present obstetric performance and HIV status. Results: Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6; CI: 1.1-12.5); delivery by caesa- rean section in previous pregnancy (O.R. 19.9; CI: 6.4-61.7); residing more than ten kilometres from Mulago hospital (O.R. 2.4; CI: 1.0-5.7) and recurrent vaginal bleeding during the current pregnancy (O.R. 7.3; CI 2.4-63.7). Conclusion: Severe bleeding in placenta praevia is associated with high maternal morbidity and mortality. The determi- nants of severe bleeding in placenta praevia can be used in the antenatal period to identify mothers at risk. These; with prompt interventions to deliver the women can be used to reduce the maternal morbidity associated with this condition

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background: The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background:The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended

Placenta praevia : facteurs epidemiologiques et pronostic foeto-maternel

La Lp(a) est une lipoparticule ayant des proprietes atherogene et thrombogene. Chez le caucasien; le taux seuil atherogene est estime a 0;30 gfl. Plusieurs etudes realisees chez le sujet de race noire n'ont pas permi de definir un taux seuil. Notre etude est une metaanalyse de six travaux realises en Cote d'Ivoire dont l'objectif principal est de preciser l'interet diagnostic de la Lp(a) chez le sujet ivoirien atteint d'affections cardiovasculaires ou d'affections a risque cardiovasculaires. Celle metaanalyse a permi de montrer que: Le taux serique moyen de la Lp(a) dose chez 1'Ivoirien sain par immunonephelemetrie etait significativement plus eleve que les taux seriques moyens de Lp(a) determines par IDR(0.34 +/-0.26g/l) et par la technique ELISA (0.33 +1- 0.28 g/l). Cependant; quelque soit la technique de dosage; le taux moyen de la Lp(a) retrouve chez l'ivoirien sain est superieur au seuil de risque cardiovasculaire determine chez les caucasiens qui est de 0.3g/1. Les taux seriques moyens de la Lp(a) des sujets atteints d'affections cardiovasculaires(AVC; IDM) et d'affections a risque cardiovasculaire (Diabete; HTA) ne different pas significativement; mais sont significativement plus eleves que les taux seriques moyens observes chez les sujets sains. La distribution des taux seriques de la Lp(a) a montre que 51pour cent des taux seriques doses par immunonephelemetrie etaient superieurs a 0.3g/l; tandis que le pourcentage de taux seriques de la Lp(a) dosee par ELISA superieurs a 0.3g/1 etait de 30pour cent; chez l'ivoirien sain. 68.8pour cent des sujets diabetiques; 84pour cent des patients hypertendus et 70pour cent des sujets atteints d'AVC et d'IDM avaient un taux de Lp(a) superieur a 0.3g/l. L'etude des correlations a montre une correlation significative et positive entre Lp(a) et le cholesterol total aussi bien chez les malades que chez les temoins; et une correlation significative et positive enlie la Lp(a) et l'apoB chez les malades uniquement. La correlation observee entre Lp(a) et le cholesterol total etait plus forte chez les malades que chez les temoins. L'etude des phenotypes de l'apo(a) a permis d'identifier 15 isoformes dans la population etudiee constituee de sujets ivoiriens sains. La taille de ces isoformes varie de 13 a 33 kiingle 4. Le phenotype 54 chez les homozygotes (43;33pour cent) et S3/S4 chez les heterozygotes (20pour cent) etaient les plus frequents. Aucun phenotype nul n'a ete detecte. D'autre part; aucune correlation n'a ete retrouvee entre la taille des isoformes de l'apo(a) et les taux seriques de la Lp(a)

Thrombose veineuse cerebrale du post partum : a propos d'un cas

La localisation cerebrale des thromboses veineuses est rare au cours de la grossesse et le post partum. Nous rapportons le cas d'une patiente de 33 ans 3eme geste 3eme pare; cesarisee a 34 semaine d'amenorrhee pour placenta praevia hemorragique; les suites post operatoires sont marquees au 6eme jour par des cephalees suivies de crises convulsives et un deficit moteur de l'hemicorps droit. Le diagnostic de thrombose veineuse cerebrale est confirme par l'angio-IRM cerebrale. Le bilan etiologique restait negatif. L'evolution etait favorable sous anticoagulant. Les auteurs mettront l'accent sur les aspects physiopathologiques; cliniques; paracliniques; therapeutiques et evolutifs de la TVC du post partum